Journey to the Center of My Issues

Pharma TRT
1

Hi Guys,

Had my labs run a couple weeks ago and here are the results. Would appreciate your feedback as I have my follow-up evaluation appointment with my Doc. tomorrow. Most of the results seem OK, although there are a couple potential stand-out values (see Free T and SHBG). As far as my symptoms, I have been experiencing the following for a couple years:

Depression, including general irritability and moodiness
Lack of drive and ability to focus
Declining sex drive and MUCH less pleasure from orgasm

Thank you,
JTBRADLEY

My personal stats. and lab values follow:

Age: 40
Height: 6-1
Waist: 34
Weight: 195

Describe body and facial hair:
Lots of body hair: arms, chest, back, legs. Plenty of hair on head. Need to shave facial hair daily. No noticeable decline in body hair in last few years.

Describe where you carry fat and how changed:
Have always carried most fat around stomach, love handles and lower back. Carry little fat around arms and legs.

Health conditions, symptoms [history]:
No known current or historical health conditions, other than low level sleep apnea (less than 5). Treatment in process.

Rx and OTC drugs, any hair loss drugs or prostate drugs ever:
None, other than Accutane 15 years ago for about 9 months and 18 years ago for about 6 months.

Describe diet:
Diet is solid. Lots of eggs, meat, nuts, vegetables. Focus on whole, unprocessed foods. Low carb, but not very low carb. Avoid grains other than oatmeal. Avoid sugars (including fruit). Eat three times daily, no snacks. Have been eating this way for about two years. Four years ago, went on a protein sparing modified fast and lost 25 lbs. Weight continued to decline in succeeding three years, drifting lower by a total of about 15 additional lbs.

Describe training:
Full body training 1-2 times per week, 1-1.5 hour sessions. Big movements: squats, deadlifts, pull-ups, bench. Also do HIIT sprints at least once a week. 8 cycles of 30 seconds each of uphill sprinting and 2.5 minutes rest between intervals.

Testes ache, ever, with a fever?
Never.

How have morning wood and nocturnal erections changed?
Used to often wake up with erection. Much less frequent now.

Lab results with ranges: See below.

Two stand-out values:

TEST RESULT UNIT REF. RANGE
Free Testosterone 73.3 pg/mL 34-246
SHBG 49.9 nmol/L 14-48

TEST RESULT UNIT REF. RANGE
Glucose (non-fasting) 92 mg/dL 70-105
SGOT (AST) 21 U/L 8-40
BUN 23 mg/dL 6-19
SGPT (ALT) 22 U/L 0-40
Creatinine, Serum 1.0 mg/dL 0.5-1.2
Bilirubin, DIR 0.1 mg/dL 0-0.3
Sodium 139 mmol/L 133-145
Bilirubin, Total 0.6 mg/dL 0.1-1.5
Potassium 4.2 mmol/L 3.6-5.5
ALK. Phosphatase 60 U/L 39-117
Chloride 102 mmol/L 96-110
Protein, Total 6.7 g/dL 5.9-8.4
Calcium 9.2 mg/dL 8.5-10.4
Albumin 4.6 g/dL 3.2-5.1
Triglycerides 94 mg/dL 0-200
Cholesterol 238 mg/dL 120-200
HDL Cholesterol 57 mg/dL 40-60
LDL Cholesterol, CALC 162 mg/dL 50-130
VLDL/CALC 19 mg/dL 5-40
CHOL/HDL/CALC 4.2 3.4-5.0
CO2 28 meq/mL 21-31
Ferritin 189 ng/mL 30-400
Iron Total 107 ug/dL 45-160
WBC 4.8 x10^3/uL 4.8-10.8
RBC 4.5 x10^6/uL 4.7-6.1
HGB 14.8 g/dL 14-18
HCT 43.9 % 42-52
MCV 97.4 fL 80-94
MCH 32.8 pg 27-31
MCHC 33.7 g/dL 32-36
RDW 13.6 % 11.5-14.5
Platelet Count 176 x10^3/uL 150-400
MPV 8.8 fL 7.4-10.4
SEGS 46.1 % 40-75
LYMPHS 44.4 % 17-45
MONOS 8.0 % 0-12
EOS 1.2 % 0-9
BASOS 0.3 % 0-3
T3 Uptake 35.7 % 24-39
T4 8.3 ug/dL 5.1-14.1
TSH 1.030 uIU/mL 0.270-4.200
FTI (T7) 3.0 uug/dL 1.0-4.4
Lipid Profile:
RPR non-reactive
ANA Latex (LE) Screen negative
Uric Acid 4.7 mg/dL 3.4-7.0
Glomerular Filt. Rate >60 mL/min/1.73m^2

Cortisol (11:00 am) 9.3 ug/dL 6.2-19.4
CRP negative

Estradiol/Estrogen 17.3 pg/mL 7.6-42.6

Vitamin B-12 679 pg/mL 243-894
Folate 19.0 ng/mL 3.1-17.5

Hemoglobin A1C 5.8 % 4.8-5.9

Homocysteine
-Total, Serum 9.6 nmol/mL 0.0-15.0

LH 3.7 mIU/mL 1.7-8.6
Progesterone 0.8 ng/mL 0.2-1.4
Prolactin 9.1 ng/mL 4.6-21.4
Prostatic Spec Antigen 1.340 ng/mL 0.0-4.0
Free Testosterone 73.3 pg/mL 34-246
SHBG 49.9 nmol/L 14-48
Testosterone, total 473 ng/dL 280-800
Insulin-Like GF 213 ng/mL 64-188

Vitamin D >60.0 ng/mL 30-100

Celiac disease profile
Endomysial IGA AB negative
Tissue transglutaminase <2 u/mL 0-3
Immunoglobulin A 201 mg/dL 70-400

2

Any input?

Thanks,
Bradley

3

So I met with the Doc. today.

He said I’m generally good, other than my high cholesterol, and would recommend mono HCG therapy to try to address my symptoms (we didn’t discuss dosage). Given my relatively low E2, the Doc. said we could monitor E2 elevation from HCG and add AI if necessary.

But just to rule out adrenal fatigue and other issues, I decided to first have saliva cortisol and urine neurotransmitter tests before going down the path of HCG.

4

fsh should be tested before starting trt… i don’t know why they test lh and not fsh… Also TRT cause been know in some cases to cause sleep apnea… Not something I would want to mess with but I have no idea how you will react… right on the bottle it says it may cause sleep apnea… Doc say anything about SHBG?

5

Thanks. We ordered an FSH test but for some reason the lab didn’t run the test (among others). As to my relatively high SHBG, he said that just the way I am–nothing really to be done about it.

6

Your high SHBG and lower E2 is an odd combination.

SHBG is made mostly by the liver.
SGPT (ALT) 22 U/L 0-40 does not indicate an issue.

SHBG also sees the SHBG in SHBG+T.
We see that TT is mid range and FT is 1/3rd of range; which makes some sense.
Perhaps T production is low and SHBG+T is not been cleared effectively by the liver.

Not harmless: Isotretinoin Influences Pituitary Hormone Levels in Acne Patients | Abstract | Acta Dermato-Venereologica

Please read the thyroid basics sticky and come back with oral body temperature data and iodine intake history.

Your body hair indicates that you probably had a good T level before. Your current status would then be tougher on you than for a guy who had lower T levels and less body hair. If you have strong male facial bone structure, that implies higher T levels when you were becoming virilized.

In my thinking, many males will have snoring issues as they age. Loss of T levels reduces the effects to some extent. TRT simply restores one to the state they would be in if their T levels had remained higher. One can argue that restoring to youthful high range T levels takes this to an extreme. Hard to argue against that implication. In this case, it is hard to tell from the stats if there is any implication re need to loose body fat.

TRT should lower total cholesterol. With high HDL, there is no current concern re health risk.

7

KSman,

Thanks for the information and for taking the time to reply.

I did read the thyroid sticky some time back and have checked body temperatures, although not to an extent that I’m able to track them over much time. I will say that I am routinely at or near 97 degrees in the morning and never seem to progress to 98.6 during the day. In addition, over the course of my life I have always run “hot” and sweated quite a lot, but that stopped a while back (2 years, maybe), so thyroid issues could certainly be a contributing factor. Finally, my iodine intake is probably low (have used non-iodized sea salt for quite some time and I don’t eat much shell fish, although I have eaten much farm raised sea food–not sure if that’s iodine-rich or not). In any event, I’ve started an iodine protocol (currently 6.25 mgs. per day until I titrate higher), targeting the overall intake recommendation of 750 mgs. over the course of the program. I’m at about day 10 right now.

As an additional data point, I do have strong male facial bone structure. I’m decently but not overly muscular and I don’t think additonal fat loss is warranted or that body fat is the cause of my issues.

What are your thoughts on mono HCG therapy?

Also, could low E2 be contributing to my lack of sex drive? Is high SHBG taking too much E2 out of my system?

Thanks again,
Bradley

8

One additional data point:

In thinking about hair loss, I’ve noticed two bare patches in the mid-quadricep region, each about the size of an iPhone. I had assumed it was from something else–say from wearing compression shorts, but the more I think about it, the less likely it seems that those particular areas would be affected. So could these bare patches be indicative of hormone losses?

I sent off my saliva and urine samples this week. We’ll see in the next 2-3 weeks what the results are.

Bradley